Does depression affect the association between prosocial behavior and anxiety? A cross-sectional study of students in China

Background: A growing number of studies have suggested that adolescents' prosocial behavior can protect against depression and anxiety. It is known that anxiety and depression are often comorbid. However, it remains unclear if when depression is present, prosocial behavior remains protective against anxiety, and if when anxiety is present, prosocial behavior remains protective against depression. The purpose of this study was to determine the association of anxiety and depressive with prosocial behavior. Methods: A large representative sample of middle-school students was recruited for a cross-sectional study and completed standardized instruments (the Children's Depression Inventory (CDI), Screen for Child Anxiety Related Emotional Disorders-Child version (SCARED-C), and Strengths and Difficulties Questionnaire (SDQ)). We used structural equation modeling (SEM) to examine the protective effect of prosocial behavior against anxiety when depression was present. Results: 0.05). Conclusion: Anxiety and depression are common in adolescence and are often comorbid disorders. However, the comorbidity is not symmetrical. Specifically, the protective effect of prosocial behavior against anxiety is weaker in depressed adolescents. Findings are discussed in light of related research and theory, and insights for intervention programs and future research are presented.